By Moran, Brendan
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Extra resources for Farquharson's Textbook of Operative General Surgery 9Ed
LOCALLY ADVANCED BREAST CANCER Primary surgery is contraindicated if there is evidence of extensive skin involvement by tumour or features of advanced disease such as inﬂammation or cutaneous oedema (peau d’orange). Similarly, when tumour or involved axillary nodes are ﬁxed to muscle, primary surgery is best avoided. In 24 Surgery of the breast and axilla these circumstances primary systemic therapy with chemotherapy or endocrine manipulation – or both – can bring advanced locoregional disease under control.
1,2 Radical surgery for breast cancer traditionally involved the excision of the whole breast and the axillary lymph nodes. The original radical operation of Halstead radical mastectomy3 included removal of the whole breast, the axillary contents and the pectoral muscles. Extended radical mastectomy was a logical extension to a Halstead radical mastectomy which achieved more radical lymphatic clearance by excision of the internal thoracic and supraclavicular nodes. However, morbidity was increased without signiﬁcant advantages in survival or local control, and these extensive procedures were for the most part abandoned.
Ideally, the muscle should be denervated to avoid future painful contractions. The donor site is closed over suction drains and the patient returned to the supine position. The latissimus dorsi muscle forms the tissue replacement for the excised breast, and its overlying ellipse of skin is sutured to the upper and lower mastectomy ﬂaps. A latissimus dorsi ﬂap is often used in reconstruction in conjunction with a submuscular silicone implant to provide adequate volume. 26 Surgery of the breast and axilla a large and the breast is small.
Farquharson's Textbook of Operative General Surgery 9Ed by Moran, Brendan